Developing a new aphasia therapy for a virtual world: the Virtual Elaborated Semantic Features Analysis (VESFA) intervention

Stroke research Priority Setting Partnerships identified a need for interventions that address wellbeing and communication. This paper outlines the development of a communication and wellbeing intervention for delivery in the virtual world, EVA Park, for people with aphasia called Virtual Elaborated Semantic Feature Analysis. The Medical Research Council framework for developing complex interventions was followed to combine evidence (literature review), underpinning theory (semantic processing theories, framework for situated language use and learning theories) and involvement with stakeholders (four people with aphasia and three speech and language therapists) in an intervention that addresses word finding, situated language and wellbeing. Evidence for the semantic word interventions and situated conversation interventions was synthesised. Theory underpinning the proposed intervention included Hebbian learning, the hub and spokes model of semantic processing, semantic spreading activation theory, the framework for situated language use and learning theories. Stakeholders with aphasia identified intervention content, an acceptable intervention regimen and gave feedback on a taster session. Speech therapists advised how the intervention could be implemented in clinical practice. Virtual Elaborated Semantic Feature Analysis is a user-informed, theory-based complex aphasia intervention that is expected to improve word finding, word use in situated conversation and wellbeing. When consulted on acceptable therapy regimens for an aphasia therapy in a virtual world, a lived experience advisory group preferred a distributed regimen (4 days a week over 8 weeks) over a more intense regimen (5 days a week over 6 weeks).Individual word retrieval activities and group conversation activities were equally prioritised by the lived experience advisory group.It is more challenging to retrieve a word in a conversation context, therefore word retrieval practiced in conversations was valued by the lived experienced advisory group.A simulated, supported, virtual space for communication practice, such as groups in the EVA Park virtual world, provides a social context for learning and experiencing success with limited loss of face. When consulted on acceptable therapy regimens for an aphasia therapy in a virtual world, a lived experience advisory group preferred a distributed regimen (4 days a week over 8 weeks) over a more intense regimen (5 days a week over 6 weeks). Individual word retrieval activities and group conversation activities were equally prioritised by the lived experience advisory group. It is more challenging to retrieve a word in a conversation context, therefore word retrieval practiced in conversations was valued by the lived experienced advisory group. A simulated, supported, virtual space for communication practice, such as groups in the EVA Park virtual world, provides a social context for learning and experiencing success with limited loss of face.